General Internal Medicine Flashcards
(44 cards)
US preventative services task force recommends two question survey for depression
- Over the past two weeks have you felt down depressed or hopeless?
- Over the past two weeks have you felt a little interest or pleasure in doing things?
Positive response to either question warrens further evaluation
What medication can you use for depression in hospice patients?
methylphenidate
What are some non-psychiatric conditions that mimic depression?
Chronic infectious disease such as HIV, endocrine disease, such as thyroid and adrenal gland, androgen deficiency, menopause, cancer, heart failure, neurologic disease, like Parkinson, or multiple sclerosis, sleep apnea
Major depressive disorder, diagnostic criteria
DSM five by the presence of five of the following symptoms during the same two-week period, at least one of which is depressed mood, or loss of interest or pleasure
1. Depressed mood.
2. Markedly diminished interest or pleasure in all or almost all activities, most of the day nearly every day.
3. Significant weight loss, when not dieting or weight gain or decreased or increased appetite
4. Insomnia, or hypersomnia.
5. Psycho, motor agitation or retardation nearly every day.
6. Fatigue or loss of energy nearly every day
7. Feelings of worthlessness or excessive inappropriate guilt,
8. Diminished ability to think or concentrate nearly every day
9. Recurrent thoughts of death, recurrent suicidal ideation, with or without a specific plan, suicide attempt.
Persistent depressive disorder, diagnostic criteria
- Depressed mood most of the day, more days not for at least two years.
- Depressants, while depressed of two or more of the following symptoms : poor appetite, or over, eating, insomnia, or hypersomnia, low energy or fatigue, Lu, self-esteem, poor concentration, difficulty making decision, feelings of hopelessness. symptoms do not a bit for more than two months
Diagnostic criteria for seasonal affective disorder
Subtype of major depressive disorder, characterized by Johndrow symptoms during autumn or winter, which result during subsequent spring. Diagnosis requires three consecutive years of symptoms. 
Peripartum, depression
Affects women within six months of giving birth, single and poor mothers at greater risk. Major depressive disorder that occurs during pregnancy or within four weeks following delivery, although clinical symptoms may not be recognized until after this. …? Unclear
Persistent complex bereavement disorder
Normal grieving, occurs and fits and starts, but gradually becomes less intense over time. Weaving that lasts more than 12 months or six months in children is associated with persistent yearning, sorrow, we occupation with the deceased. Districts, normal function, or social relationships, and is out of proportion to cultural norms. 
Management for depression 
- psychotherapy, cognitive, behavioral therapy, psychodynamic therapy, interpersonal therapy.
- Psychopharmacology. 
Classes of anti-depressant drugs
- SSRI.
- SNRI
- tricyclic antidepressants.
- Other agents: bupropion, mirtazapine, trazodone
Pharmacotherapy for depression
Patients who do not respond to photos antidepressant monotherapy for six weeks me respond to a different antidepressant drug are there from the same or different class or the addition of the second antidepressant drug. You can also add antipsychotic drug. 
Antipsychotic drugs for depression to use in combination
- Aripiprazole with any antidepressant
- Quetiapine extended release with any anti-depressant
- Olanzapine with fluoxetine
Anti-depressant contraindicated in seizure disorder
Bupropion
Serotonin syndrome
SNRI and MAOIs.
Characterized by altered mental status, autonomic, instability, neuromuscular, hyperactivity, that is potentially lethal
Treatment of seasonal affective disorder
Involves daily therapeutic exposure of 30 to 60 minute of 10,000 Luxor visible light. Antidepressant drugs and cognitive behavioral therapy are also used.
Bipolar II disorder
Major depression, and hypomania. is present for at least four days.
Bipolar I disorder
One or more manic episodes
A manic episode is characterized by at least seven days of severe, abnormally, expansive, euphoric, or irritable mood associated with three of the following symptoms. Grandiosity or inflated self-esteem, pressured speech, flight of ideas, distractibility, increase, goal, directed activity or psychomotor agitation, excessive involvement and pleasurable activities with high potential for adverse consequences, such as pending spree’s or sexual encounters, lessened need for sleep.
Management of bipolar disorder
Psychiatrist involvement. Pharmacotherapy involves mood, stabilizer, such as lithium, valproic acid, and carbamazepine, or lamotrigine
Treatment of acute manic episodes
Lithium or valproic acid and an atypical, antipsychotic drug such as olanzapine, quetiapine or aripiprazole
Diagnostic criteria for generalized anxiety
- Excessive anxiety or worry about a number of events or activities for example school or work occurring more days than not for six months or longer.
- The patient recognizes it is difficult to control the worry
- The anxiety or worry is associated with three or more of the following symptoms. Restlessness, easy, fatigability, difficulty, concentrating, irritability, muscle tension, sleep disturbance.
- The anxiety, worry or symptoms, cause an impairment at school, work or other setting, and cannot be attributable to medical or other psychiatric conditions, medication, or substance abuse.
Generalized anxiety treatment
1.Cognitive behavioral therapy/psychotherapy
2.SSRI, SNRI, tricyclic, antidepressants, and benzodiazepine for short term (6 wks)
Panic disorder 
Panic disorders characterized by recurrent unexpected, an abrupt searches of extreme anxiety that peak within minutes and is a company by four or more of the following symptoms: palpitations, sweating, trembling, dyspnea, choking sensation, chest pain, nausea or abdominal pain, lightheadedness, chills, numbness, or tingling, feeling, detached, fear of losing control, or dying.
Diagnosis requires that an attack default by at least one month of worry by the patient that he, or she will experience a recurrent attack 
Treatment of panic disorder
SSRI or SSRI in combination with CBT, you can consider a short course of a long acting benzodiazepine like clonazepam for the first few weeks as the anti-depressant is escalated
Social anxiety disorder
Treatment
Characterized by severe, persistent, anxiety, or fear of social or performance situations like public speaking, meeting, unfamiliar people that last six months or longer.
SSRI or SNRI venlafaxine
